Resmed VPAP S9 Auto Pressure settings

[Riverlea]

Riverlea here. I'm doing lots of reading on this site and on the web and am s-l-o-w-l-y coming to understand my machine. I want to ask members who have this machine about their pressure settings. What is 'typical', if there is such a thing? I'm having a big aerophagia problem and the IPAP is certainly involved. My current pressures are: IPAP 14, EPAP 7, SP 4. Since I began two weeks ago, the doc lowered the SP from 6 to 4, which has made the machine tolerable (it was causing centrals and they have backed off - the doc said he made a "mistake".). At the (excellent) suggestion of a member here, I then dropped the IPAP from 15 to 14, and that helped with the aerophagia. The doc then sanctioned this (retroactively!) and said I could try 13 for the IPAP. Whoa, no good - 13 didn't control my apnea, so I'm fence-sitting at 14. I'd like members to tell me what they think of the setting range I'm now struggling with. It seems like quite a wide spread? Thanks!!! I live a five-hour drive from my doc, so I really need your advice. I'm highly motivated to make this work but I'm still having AHI's at 15 and pain and waking from the aerophagia.

[ozze_dollar]

Riverlea here. I'm doing lots of reading on this site and on the web and am s-l-o-w-l-y coming to understand my machine. I want to ask members who have this machine about their pressure settings. What is 'typical', if there is such a thing? I'm having a big aerophagia problem and the IPAP is certainly involved. My current pressures are: IPAP 14, EPAP 7, SP 4. Since I began two weeks ago, the doc lowered the SP from 6 to 4, which has made the machine tolerable (it was causing centrals and they have backed off - the doc said he made a "mistake".). At the (excellent) suggestion of a member here, I then dropped the IPAP from 15 to 14, and that helped with the aerophagia. The doc then sanctioned this (retroactively!) and said I could try 13 for the IPAP. Whoa, no good - 13 didn't control my apnea, so I'm fence-sitting at 14. I'd like members to tell me what they think of the setting range I'm now struggling with. It seems like quite a wide spread? Thanks!!! I live a five-hour drive from my doc, so I really need your advice. I'm highly motivated to make this work but I'm still having AHI's at 15 and pain and waking from the aerophagia.

My device settings are:
EPAP 4.0
Max PS 15.0
Min PS 5.0

[robysue]

My current pressures are: IPAP 14, EPAP 7, SP 4. Since I began two weeks ago, the doc lowered the SP from 6 to 4, which has made the machine tolerable (it was causing centrals and they have backed off - the doc said he made a "mistake".). At the (excellent) suggestion of a member here, I then dropped the IPAP from 15 to 14, and that helped with the aerophagia. The doc then sanctioned this (retroactively!) and said I could try 13 for the IPAP. Whoa, no good - 13 didn't control my apnea, so I'm fence-sitting at 14. I'd like members to tell me what they think of the setting range I'm now struggling with. It seems like quite a wide spread? Thanks!!! I live a five-hour drive from my doc, so I really need your advice. I'm highly motivated to make this work but I'm still having AHI's at 15 and pain and waking from the aerophagia. (emphasis added)

Since you are using a Resmed VPAP S9 Auto, that range is not quite as wide as you think it is.

The S9 VPAP adjusts the IPAP and EPAP at the same time and always maintains a constant Pressure support (PS). Since your PS = 4, that means that at all times during the night, IPAP - EPAP = 4.

Your pressures start off at: EPAP = 7 and IPAP = 11 = 7 + 4. Since your max IPAP = 14, that means that when your IPAP reaches the max, your EPAP must be 10cm.

Hence your pressure ranges are:

• EPAP goes from 7 to 10
  IPAP goes from 11 to 14

A three cm range for IPAP (and for EPAP) is not a particularly wide open range.

You say that your AHI is still running around 15. What's the make up of the AHI? In other words, what are the CAI, OAI, and HI that make up that total AHI = 15? If they are mostly OAs you might want to bump that min EPAP up by .05 cm or 1cm and leave the max IPAP alone.

[Riverlea]

Robysue,

Thank you so much for your detailed reply to my question. At present I don't know how the AHI breaks down. I'll ask the doc when I see him next week. In the meantime, is there any way I can glean this info myself from the machine? BTW, I like your suggestion concerning the EPAP. I know I can't go any lower with the IPAP because I tried, and my sleep was disturbed and the AHI went up. But the idea of raising the EPAP sounds reasonable to me.

Also, I've been reading to understand how my VPAP works. I like your explanation, and at last the 'light bulb' has switched on...

Riverlea

[jweeks]

At present I don't know how the AHI breaks down. I'll ask the doc when I see him next week. In the meantime, is there any way I can glean this info myself from the machine?

Hi,

It would help greatly if you can get the Resmed software and read your own data card. That would let you see the graphs so you would know what type of events you are having, at what times of the night, and how the machine is attempting to correct the issue. Machine data isn't as good as 24-channel sleep study data, but it is very helpful for fine-tuning and for giving clues on where to go next.

-john-

[Riverlea]

OP here, Riverlea. I like the idea of getting the Resmed software. Will do. In the meantime I was able to figure out how to read the AHI breakdown on my machine: the rate was running at around 16, and 15 of those were central sleep apneas. Is it still a good idea to raise the EP a notch? I tried raising it from 7 to 8 during a nap, and found no difference in the AHI's. I don't have any health issues (except this big one!) and I really don't understand why I'm experiencing the centrals or what I can do about them. Any advice would be appreciated.

[Pugsy]

the rate was running at around 16, and 15 of those were central sleep apneas. Is it still a good idea to raise the EP a notch?

Did you have any centrals mentioned in either your initial sleep study or the titration sleep study?

Those 16/15 rate numbers...is that all night or per hour as in Apnea Index? With a predominance of Centrals I wouldn't be raising the pressure..it won't help centrals and could make them worse.

[Riverlea]

Did you have any centrals mentioned in either your initial sleep study or the titration sleep study?

Those 16/15 rate numbers...is that all night or per hour as in Apnea Index? With a predominance of Centrals I wouldn't be raising the pressure..it won't help centrals and could make them worse.

Pugsy - My original sleep study, without treatment, showed very few centrals. My 'treatment' sleep study showed primarily centrals. My doctor said he thinks they are "treatment induced", due to the fact that my brain stem got used to initiating breathing when the co2 level got too high, rather than when the o2 level dropped. Therefore, when the machine is putting oxygen into my lungs, the brain fails to respond. He thinks it may go away within a few months. Having said all that, it also seems to me that it has some weird connection to my aerophagia. I've been on treatment for three weeks now and the apnias seem pretty steady and persistent. Any advice?

[Riverlea]

BTW - how do I get introduce those cool 'quote bars' into my post?

Also - I'm getting the readings off my machine, and I assume the 16/15 AHI means per hour.

[Pugsy]

how do I get introduce those cool 'quote bars' into my post?

Once you have blank page in front of you just highlight the portion you want to quote...then click "Quote" by the ID name of person you are quoting.
Or you can use the Quote buttons on the editor (just to the right of spell check) and copy/paste a portion of a comment that you have copied to your clipboard. I do it the first way..less steps.

Okay, centrals likely what we called pressure induced centrals. It happens to about 10 to 15 % of the people put on CPAP. Increasing your pressure won't help and will likely increase the centrals.

Instead you need to lower your pressure in stages to find a place where your obstructive events (Hyponeas and obstructive apneas) are still controlled well and limit the centrals. The centrals may or may not go away with time. Sometimes they do and sometimes they don't.

Take a look at this thread and you will get an idea what I mean. Click on the links in his posts to see his reports
viewtopic.php?t=68846

You are using a different machine but the principle is the same. I would start with IPAP down to 13.
When you evaluate your AHI...Centrals...no amount of pressure will fix those and obviously does make them worse.

[Riverlea]

Pugsy - I looked at the thread - amazing. Firehope's situation is very much like mine - even the numbers are similar. How can I obtain those graphs to post on this site? I will try my IP at 13 tonight. But so I'm clear - the EP at 7 makes no difference?

[Pugsy]

But so I'm clear - the EP at 7 makes no difference?

Unknown. But in theory since higher pressures typically are the culprits for pressure induced centrals we would normally think IPAP as being first culprit to modify. We still need sufficient EPAP to effectively prevent the obstructive apneas. So it still may need to be modified also.

How to post images of reports? I use screen shots. Easier for me.
This is how I do it.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[Grand-PAP]

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[Riverlea]

Dear Grandpap (I could be older than you are) - I'm far from being offended! Just got back from my five-hour long drive back from my doc. I'll take the time to analyze what you've said tomorrow when I'm more rested. But I think you're correct in the general gist of what you say! I've been monkey-ing around out of desperation: six more weeks to 'delivery date' of my first to-be-published novel. I'm very frustrated and was told today that my case is difficult and complicated, due to the centrals. Apparently they are not caused by pressures, but rather by my brain's reaction to the treatment. Oh - and I'm impatient by nature. Another problem: I need to take the time to get the resmed software and figure out how to use it... tech-resistant! I could use some help there. - Riverlea.

[rested gal]

was told today that my case is difficult and complicated, due to the centrals. Apparently they are not caused by pressures, but rather by my brain's reaction to the treatment.

Sounds like the doctor is saying he thinks you have "CompSA" (complex sleep apnea), also known as "CSDB" (complex sleep disordered breathing.)

An "ASV" (adapt servo ventilator) machine seems to be the most effective treatment for "CompSA" ("CSDB") if the centrals brought on by treatment don't subside on their own over time (a month or more perhaps?) with the more common xpap machines like CPAP or bilevel machines. Autotitrating (auto mode in cpap or auto mode in a bilevel) is probably not a good way to deal with CompSA/CSDB. Did the doctor mention the possibility of switching you to an ASV machine?